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,/EMCInsurance Companies <br />EMPLOYERS MUTUAL CASUALTY COMPANY POLICY NUMBER: 3D6- 49- 04 - - -15 <br />SAND B HOLDINGS, LLC EFF DATE: 09/01/14 EXP DATE: 09/01/15 <br />G E N E R A L L I A B I L I T Y P O L I C Y <br />D E C L A R A T I O N S <br />ENDORSEMENT SCHEDULE <br />DATE OF ISSUE: 08/20/14 <br />FORM: IL7131A (ED. 04 -01 <br />(CONTINUED) <br />005 SB 3D64904 <br />EDITION <br />FORM <br />DATE <br />DESCRIPTION /ADDITIONAL INFORMATION PREMIUM <br />*CG0001 <br />04 -13 <br />COMMERCIAL GEN LIABILITY COV FORM <br />*CG2012 <br />04 -13 <br />AI- STATE /GOVT AGCY /SUBD /POLIT SUBD /T <br />NAME /CONCESSIONAIRES /JOB TITLES/ <br />POLITICAL ENTITY /ASSOC. OR ORG. /ETC. <br />STATE OF COLORADO DIV OF <br />RECLAMATION MINING & SAFETY <br />1313 SHERMAN ST., RM 215 <br />*CG2013 <br />04 -13 <br />AI -STATE /GOVT /SUBD /POLIT SUBD /AUTHOR <br />NAME /CONCESSIONAIRES /JOB TITLES/ <br />POLITICAL ENTITY /ASSOC. OR ORG. /ETC. <br />STATE OF COLORADO DIV OF <br />RECLAMATION MINING & SAFETY <br />1313 SHERMAN ST., RM 215 <br />*CG2028 <br />04 -13 <br />AI- LESSOR OF LEASED EQUIPMENT <br />NAME /CONCESSIONAIRES /JOB TITLES/ <br />POLITICAL ENTITY /ASSOC. OR ORG. /ETC. <br />WAGNER EQUIPMENT / WAGNER RENTS <br />18000 SMITH ROAD <br />AURORA CO 80011 <br />CG2144 <br />07 -98 <br />LIMITATION COV DESIG PREMISES /PROJEC <br />PREMISES /PROJECT: <br />627 24 1/2 RD, UNIT I <br />GRAND JUNCTION, CO 81505 <br />CG2146 <br />07 -98 <br />EXCL -ABUSE OR MOLESTATION <br />CG2147 <br />12 -07 <br />EXCL- EMPLOYMENT RELATED PRACTICES <br />*CG2150 <br />04 -13 <br />AMENDMENT /LIQUOR LIABILITY EXCLUSION <br />CG2154 <br />01 -96 <br />EXCL -OPER COV BY CONSLDATED INS PROG <br />DESCRIPTION AND LOCATION OF OPERATION(S): <br />-------------------------------------------- <br />ANY AND ALL CONSOLIDATED (WRAP UP) INSURANCE <br />PROGRAM OPERATIONS <br />CG2167 <br />12 -04 <br />FUNGI OR BACTERIA EXCLUSION <br />CG2170 <br />01 -08 <br />CAP /LOSSES FROM CERT ACTS /TERRORISM <br />CG2176 <br />01 -08 <br />EXCL PUNITIVE DMGS ACTS OF TERRORISM <br />CG2294 <br />10 -01 <br />EXCL -DMG TO WORK PERFORMED BY SUB <br />CG7001A <br />10 -12 <br />GENERAL LIABILITY SCHEDULE <br />*CG7003 <br />10--13 <br />GL QUICK REFERENCE (OCCURRENCE) <br />CG7191 <br />01 -13 <br />COMM'L GENERAL LIABILITY AMENDMENT <br />*CG7315.2 <br />10 -13 <br />CONTINUOUS OR PROGRESS INJ /DMG EXCL <br />CG7422 <br />08 -00 <br />EXCL INJ /DAMAGE FROM EARTH MOVEMENT <br />CG7584 <br />10 -06 <br />MOBILE EQUIPMENT /AUTO AMENDMENT <br />*CG8254 <br />06 -14 <br />ADVISORY NOTICE TO POLICYHOLDERS <br />IL0021 <br />09 -08 <br />NUCLEAR ENERGY LIAB EXCL /BROAD FORM <br />*IL0125 <br />11 -13 <br />COLORADO CHANGES - CIVIL UNION <br />IL0228 <br />09 -07 <br />CO CHANGES - CANCELLATION /NONRENEWAL <br />IL7028 <br />10 -05 <br />ASBESTOS EXCLUSION <br />DATE OF ISSUE: 08/20/14 <br />FORM: IL7131A (ED. 04 -01 <br />(CONTINUED) <br />005 SB 3D64904 <br />